Healthcare Provider Details

I. General information

NPI: 1457887564
Provider Name (Legal Business Name): SHATARA GOVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 181175
FAIRFIELD OH
45018-1175
US

IV. Provider business mailing address

PO BOX 181175
FAIRFIELD OH
45018-1175
US

V. Phone/Fax

Practice location:
  • Phone: 513-614-6300
  • Fax:
Mailing address:
  • Phone: 513-614-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: